Custom dental attachment placement appliances and appliance manufacturing methods

ABSTRACT

A method of producing a custom dental anchor application appliance may be provided. The appliance may be for mounting one or more anchors to teeth of a patient. The appliance may be for use in orthodontic aligner treatment. The method may include forming a dental appliance. The forming may be done using a three-dimensional printing approach. The appliance may include a body. The body may include at least one anchor-locating area. The anchor-locating area may be shaped to conform to a mounting area on a surface of a tooth. The appliance may include a receiving structure. The receiving structure may be configured to removably support a dental anchor. The dental anchor may be of a predefined configuration in a fixed position and orientation relative to the body.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a non-provisional of U.S. Provisional PatentApplication No. 62/627,304, which was filed on Feb. 7, 2018, and ishereby incorporated by reference herein in its entirety.

FIELD OF TECHNOLOGY

This invention relates generally to the positioning and mounting ofattachments on teeth for use with aligners during the course oforthodontic treatment. More specifically, this invention relates tocustom-fitted attachment positioning and securing shells, and to themanufacture and use of such shells for the positioning and mounting oforthodontic attachments.

BACKGROUND

Conventionally, polymeric orthodontic positioning appliances, such asdental aligners, are used to reposition the teeth of patients. Suchappliances are typically designed to cover the teeth, and, thereby,apply forces to the covered teeth. The forces cause the teeth to movetowards an arrangement that an orthodontist determines to be ideal, orto otherwise satisfy a treatment objective. Such appliances include athin polymer shell of elastic material. The material may conform to apatient's tooth configuration, but may be slightly out of alignment withan initial tooth configuration. Placement of the polymeric shell overthe teeth applies controlled forces in specific locations. Thecontrolled forces gradually move the teeth into a new configuration.Repetition of this process with successive appliances including newconfigurations eventually moves the teeth through a series ofintermediate configurations to a final desired configuration.

There may be various goals associated with orthodontic treatment. Suchgoals may include moving the teeth of a patient as closely as possibleto final tooth positions determined ideal for achieving the desiredtreatment result. Such goals may also include minimizing the time duringwhich a patient must wear appliances used for the treatment. Such goalsmay further include minimizing patient office visits. Such goals mayalso include minimizing an amount of time orthodontic practitioners arerequired to treat the patients (colloquially, “chair time”). Aligners,when used in combination with attachments on the teeth, help attain theaforementioned goals during the course of treatment of a patient.

When a patient positions a positioning appliance, such as an aligner,over a prescribed group of teeth, one or more of the teeth will providea base—i.e., anchor region—for holding the positioning appliance inplace while the stiffness of the polymeric material imparts a resilientrepositioning force against one or a portion of the remaining teeth. Bydesigning the appliance to cover the teeth, a much larger contactsurface area is afforded compared to traditional orthodontic treatmentusing brackets and wires.

However, such anchoring and repositioning abilities of removable elasticpositioning appliances still depend on the native tooth surfaces andother dental features of the patient's teeth. This inadequacy to providesufficient anchoring on the teeth to be repositioned is a drawback andoften prevents using aligners to treat patients requiring morecomplicated forces or movements. For example, shell-like polymericpositioning appliances have difficulty applying certain forces toindividual teeth, such as extrusive force (e.g., pulling or raising atooth relative to the jaw).

To overcome these limitations, conventional aligner treatment uses oneor more attachment devices (typically referred to as attachments). Theattachments are bonded to preselected attachment points on the teeth ordental features in order to provide the appropriate physical leverage.Attachment devices coupled to teeth have been utilized in orthodontictreatment. Attachment devices can also improve force delivery and/orrepositioning of the teeth, e.g., with shell-shaped appliances. Specificdesign and location of attachment devices provide attainable and moreeffective repositioning forces, anchoring ability and applianceretention that would otherwise not be possible without the use of theattachment. Attachment devices in combination with removable dentalpositioning appliances provides the patient with the benefits ofremovable appliances while retaining the ability to intrude/extrude,rotate, and otherwise manipulate teeth that require more difficultmovements. In the past, conventional systems required braces to providethe more difficult movements.

Attachments are typically constructed of varying materials, shapes andsizes, and can be bonded to the labial or lingual surfaces of teeth inorder to interact with aligners in a variety of different ways.Attachments can be applied to a patient's teeth prior to treatment withaligners. Attachments are precisely placed and secured to teeth usingadhesives, flexible bands and/or connecting ligatures.

Attachments may be fabricated prior to tooth attachment. Attachments mayalso be substantially assembled at the orthodontic practitioner's officeprior to, or in conjunction with, positioning on the patient's tooth(e.g., molded composites, etc.).

Conventional techniques for both creating attachments and securing theattachments to teeth have been shown to be inefficient, time-consumingand error-prone. The expertise of the orthodontist, the application ofdental adhesives and the application of curing lights are also oftenrequired when creating attachments and securing the attachments toteeth. Positioning attachments individually can be time consuming, andrequire careful handling to ensure precise placement. Proper placementof attachments may ensure proper engagement and interaction of theattachment with a designed feature on the aligner. The designed featuremay provide a desired physical leverage which creates a desired force ona tooth to produce a specific movement of the tooth during treatment.

In some instances where attachments are utilized, errors may occur asattachments made by the practitioner may not always conform to aprescribed or ideally desired shape and/or may not bond in the optimallocation or orientation necessary to engage one or more features on theprescribed aligner as digitally designed. Accordingly, the desiredeffect of including the attachment in treatment may not be realized.Manufacturing limits, errors in attachment or appliance formation (e.g.,attachment-receiving well of an appliance) may lead to error inappliance/attachment engagement, such as misalignment or less than idealcoupling between an attachment and appliance. Accordingly, acorresponding orthodontic appliance may not ideally couple or engagewith the attachment as intended, leading to errors in force delivery andthe patient's orthodontic treatment.

These limitations in the design and application of attachments do notfurther the goals of orthodontic treatment, specifically minimizing thetime of the orthodontic practitioners treating patients (chair time) andoften lead to increased office visits necessary for their application.

One prior art solution was created to remedy some of the above describedproblems associated with attachment design, installation, andinteraction with the aligner by modulating a fit between an attachmentand an aligner. This solution includes an attachment-based orthodontictreatment system including disposing or positioning a tactile objectrelative to the attachment and attachment engaging portion (e.g.,attachment-receiving well) of the orthodontic appliance so as to affectengagement between the attachment and the orthodontic appliance. Forexample, a tactile object can be disposed at least partially between theattachment and attachment receiving well of the appliance. This priorart solution does not solve the problem of initially securing anattachment with precision and accuracy so as to increase the quality ofa fit of the attachment to the orthodontic appliance. Rather, itoverlooks the need for precision in the installation of attachments,assumes these issues are insurmountable and proposes including tactileobjects inside aligners to diminish the effects created by the abovedescribed mounting issues.

Aligner treatment includes, and plans for, the use of attachments duringthe staging and digital design of the treatment plan. Therefore,aligners are manufactured with features for interacting with attachmentsto be applied by the orthodontist.

Accordingly, it would be desirable to provide a system for securelyapplying attachments to the teeth including a polymeric shell alignerpreloaded with attachments that can be easily applied to the arch of apatient, and simultaneously secure all attachments in place prior totreatment with minimal orthodontist oversight and chair time. It wouldbe further desirable to provide a system for patient-applyable andpatient-removable attachments, thereby removing the necessity for anoffice visit by the patient.

SUMMARY

A method for using a custom dental orthodontic aligner treatment issystem is provided. The method may include receiving a three-dimensionalscan of a patient's teeth. The method may include computing a sequenceof aligners required to conform the patient's teeth to a desiredformation. The method may include computing a size and a location of atleast one anchor required to secure each aligner of the computedsequence of aligners.

The method may include three-dimensionally printing a non-treatmentaligner. The non-treatment aligner may be for mounting the at least oneanchor to the patient's teeth.

The non-treatment aligner may include a body. The body may include atleast one anchor-locating area.

The non-treatment aligner may include a receiving structure. Thereceiving structure may be located within a predetermined vicinity ofthe anchor-locating area. The receiving structure may hold the at leastone dental anchor. The receiving structure may hold the at least onedental anchor in a predefined configuration. The receiving structure mayhold the at least one dental anchor in a fixed position and/ororientation relative to the body. The fixed position and/or orientationmay bring a mounting surface of the at least one anchor into contactwith a mounting area on a surface of at least one of the patient's teethwhen the mounting surface of the anchor is in conforming contact withthe mounting area on the surface of the tooth. The receiving structureis configured to release the anchor from the body after the anchor isbonded to the tooth.

The non-treatment aligner may include a releasable adhesive. Thereleasable adhesive may be located between the at least one anchor andthe body.

The non-treatment aligner may include a second adhesive. The secondadhesive may be located on the mounting surface of the anchor.

The method may include three-dimensionally printing a first aligner. Thefirst aligner may be included in the sequence of aligners. The firstaligner may include pressure-sensitive sensors.

The method may include transporting the non-treatment aligner and thefirst aligner to the patient.

BRIEF DESCRIPTION OF THE DRAWINGS

The objects and advantages of the invention will be apparent uponconsideration of the following detailed description, taken inconjunction with the accompanying drawings, in which like referencecharacters refer to like parts throughout, and in which:

FIG. 1A shows an illustrative, top down view of an appliance accordingto certain embodiments;

FIG. 1B shows an illustrative, elevational view of an applianceaccording to certain embodiments;

FIG. 1C shows an illustrative, enlarged view of a portion of anappliance according to certain embodiments;

FIG. 2 shows an illustrative, top-down view of an appliance according tocertain embodiments;

FIG. 3A shows an illustrative, elevational view of an appliance with anattachment (or anchor) according to certain embodiments;

FIG. 3B shows a close-up view of an attachment (or anchor) according tocertain embodiments;

FIG. 4 shows another illustrative, elevational view of an applianceaccording to certain embodiments;

FIGS. 5A, 5B, 5C and 5D show illustrative, top-down views of anappliance with an attachment (or anchor) according to certainembodiments;

FIGS. 6A, 6B, 6C and 6D show an illustrative, elevational view of anappliance over a single tooth according to certain embodiments;

FIG. 7A shows a prior art system;

FIG. 7B shows an illustrative system for use according to certainembodiments;

FIG. 7C shows another illustrative system for use according to certainembodiments;

FIG. 7D shows yet another illustrative system for use according tocertain embodiments; and

FIG. 8 shows an illustrative aligner that includes various attachments.

DETAILED DESCRIPTION OF THE DISCLOSURE

A custom dental anchor application appliance is provided. The appliancemay enable one or more anchors (also referred to herein as“attachments”) to be mounted to the teeth of a patient. The anchors maybe for use in orthodontic aligner treatment.

The appliance may include a body. The body may have at least oneanchor-locating area. The anchor-locating area may be shaped to conformto a mounting area on the surface of a tooth. The anchor-locating areamay include a receiving structure and/or a receptacle (described infurther detail below). The anchor-locating area may include an areapartially or completely surrounding a receiving structure and/orreceptacle. The anchor-locating area may include any other suitablearea.

The body may include a receiving structure. The receiving structure maybe located within the anchor-locating area. The receiving structure maybe coated, partially or completely, with a layer of releasable dentaladhesive. The receiving structure may hold an anchor in a predefinedconfiguration. The predefined configuration may be at a fixed positionand orientation relative to the body. The predefined configuration maybring a mounting surface of the anchor into contact with the mountingarea on a surface of the tooth. The mounting surface of the anchor maybe brought into conforming contact with the mounting area on the surfaceof the tooth. The receiving structure may be configured to release theanchor from the body at some predetermined time, or in response to somepredetermined stimuli, after the anchor has been bonded to the tooth.

The body may include a shell. The shell may have a plurality ofcavities. A cavity may include geometries. The geometries may be shapedto receive teeth. A cavity may include a receiving structure. In certainembodiments, the predefined configuration may be considered as one ofthe cavities.

A method for applying a dental anchor may also be provided. The methodmay include placing an appliance such that the anchor-locating areaconforms to a mounting area on the surface of a tooth. The anchor may beremovably secured to the body using a pressure-sensitive adhesiondevice. The anchor may include a layer of removable cement, or any othersuitable releasable dental adhesive, for bonding the anchor to thetooth.

In some embodiments, the anchor may include a layer of conventionaldental cement. The cement may be used to bond the anchor to the tooth.

The method may include applying a curing light to the body, or someportion of the body, of the appliance. The curing light may be appliedto the body of the appliance after the appliance is placed on the teeth.The curing light may be applied to the portion of the appliance thatholds the anchor. Upon completion of the curing of the removable cementor other suitable releasable or non-releasable dental adhesive, the bodyof the appliance may be removed from the teeth. The anchor may remainadhered to the teeth after removal of the appliance.

In certain embodiments, the shape of the anchor may be a first shape.The shape of the receiving structure may be a second shape. In suchembodiments, the first shape may not conform to the second shape. Thefirst shape and the second shape may be different shapes.

A custom dental orthodontic aligner treatment system may be provided.The system may include receiving a three dimensional scan of a patient'steeth.

The system may include computing a sequence of aligners. The sequence ofaligners may be required to manipulate the patient's teeth to a desiredformation. The system may include computing a size and a location of atleast one anchor. The at least one anchor may be used to secure eachaligner of the computed sequence of aligners. The at least one anchormay be used to secure one or more aligners of the computed sequence ofaligners.

The system may include three-dimensionally printing a non-treatmentaligner. The non-treatment aligner may be for mounting the at least oneanchor to the patient's teeth. The non-treatment aligner may include abody having at least one anchor-locating area. The anchor-locating areamay be shaped to conform to a mounting area on the surface of a tooth.The non-treatment aligner may include a receiving structure.

The receiving structure may hold the anchor in a predefinedconfiguration. The predefined configuration may include a fixed positionand orientation relative to the body. The predefined configuration maybring a mounting surface of the anchor into conforming contact with themounting area on the surface of the tooth.

The non-treatment aligner may include a releasable adhesive. Thereleasable adhesive may be positioned between the anchor and the body.The non-treatment aligner may be patient-applyable. The non-treatmentaligner may be patient-removable.

The non-treatment aligner may include a second adhesive. The secondadhesive may be located on the mounting surface of the anchor. Thesecond adhesive may be removable cement.

The second adhesive may be constituted of or include an engineeredmarine mussel protein. It should be appreciated that an adhesivecontaining a mussel protein may be easily removable—e.g., with aninfrared or ultraviolet light. Therefore, an adhesive containing anengineered marine mussel protein may be a desirable adhesive in order toenable a patient to remove the anchor absent practitioner involvement.

Marine mussels secrete a glue-like sticky material, known as byssus,which is responsible for the strong adhesion to rocks and other surfacesin a turbulent marine environment. The byssus is a bundle of thread-likematerials that spreads out in a radially outward direction. It consistsof four parts, namely, plaque, thread, stem, and root. Mussel byssus isproteinaceous. In other words, mussel byssus is a protein derived frommarine mussels. Byssal threads are attached to the root at the base ofmussel foot where a combination of 12 retractor muscles controls thetension in them. More than 25 different mussel foot proteins (mfp) havebeen identified in byssus, out of which 5 (mfp-2 to mfp-6) are unique toplaque. These 5 mfp have a high content of the usually rare modifiedamino acid 3, 4-dihydroxy-L-phenylalanine (hereinafter “DOPA”)

As shown in (1) above, DOPA includes a catechol moiety. When combinedwith oxidant cations from seawater under basic pH conditions, catecholoxidation of the catechol moiety of DOPA produces quinine. The quininecan form a cross-linked polymer matrix in the bonding network. Further,when bonding to rocks, the catechol moiety of DOPA may undergo chelationwith inorganic oxides found in the rock. Cohesion between molecules ofDOPA is aided by multivalent cations, such as Fe3+ and Ca2+ ions. Thesecations form metal complexes between non-oxidized catechols of DOPA andfacilitate wet adhesion of the bonding network in seawater. It has beenfound that it is the catechol functionality of DOPA that gets attachedwith external surface during the adhesion process and so at leastfacilitates the adhesion of the mussel to a variety of substrates,including wood, metal, and mineral surfaces, among others, whensubmerged in seawater. Embodiments of an orthodontic adhesive systeminclude selected engineered marine mussel proteins or similar componentsso as to mimic the attachment and/or detachment functionality of themussel in the oral environment. The engineered marine mussel protein maybe synthesized or may be genetically engineered.

In an exemplary embodiment, the engineered marine mussel protein of theorthodontic adhesive system may include a monomer having a catecholmoiety and/or a catechol-like moiety and therefore have similarproperties to DOPA, as is shown in (1). The catechol moieties and/orcatechol-like moieties of the orthodontic adhesive system includenitrocatechol or one or more nitrocatechol derivative-containingcompounds, which provide chelation, self-polymerization, andcrosslinking functionality. By way of further example, an exemplarycatechol-like containing compound may have a wet adhesive group thatbinds to enamel. The wet adhesive group may include one or morefunctional monomers that crosslink with other components of the adhesivesystem. The functional monomers include at least one of a phosphonateand a cyclic disulfide moiety, both of which can undergo a reaction witha polymerizable group of the monomer.

In one embodiment, the bond between the nitrocatechol derivative moietyand the biologically acceptable polymer may be cleaved upon exposure tolight. In this way, the orthodontic adhesive system may be capable ofbeing debonded via light exposure. By way of example, the layer mayinclude a photocleavable moiety. In that regard, exposing the bondbetween the nitrocatechol derivative-containing compound and thebiologically acceptable polymer to IR light may weaken or break thebond. By way of example, a typical orthodontic bracket may be bonded tothe tooth and achieve a shear strength of from 10 MPa to 20 MPa. IR orUV light exposure may reduce that shear strength to 1 MPa or less. As aresult, the nitrocatechol derivative may remain attached to the surfacewhile the biologically acceptable polymer becomes detached from thenitrocatechol derivative moiety. As applied to the embodiment, forexample, when exposed to IR light, the layer may denature, in which casethe layer may break down so that the attachment and the layer may bereleased from the tooth. Following debonding, an additional layer mayremain on the tooth surface. Thus, during treatment, a dental attachmentmay be strongly adhered to the teeth of a patient when desired, but thenmay also be easily removed from the teeth when treatment is completed orwhen the device needs repositioning or replacement, by exposing theadhesive to an IR light source.

The system may include three-dimensionally printing a first aligner inthe sequence of aligners. The non-treatment aligner and/or the firstaligner may include pressure-sensitive sensors or any other suitablesensors. The sensors may determine teeth placement and pressureinformation. The information may be transmitted to a computing system.The information may be transmitted to a computing system via a Bluetoothconnection between the sensors and a patient's mobile device. Thepatient's mobile device may then transmit the information to thecomputing system. In some embodiments, the sensors may be used toprovide information regarding teeth placement, pressure on teeth andongoing tooth movement.

The transmitted information may be used to compute a second treatmentaligner. The second treatment aligner may also include sensors. Thesensors may operate in a similar fashion to the sensors on the firsttreatment aligner.

A detection instrument may emit input signals to resonate the twoinductive electrodes of the sensors such that an output signal isemitted by the sensors in return. The detection instrument thereaftercollects the output signals emitted by the sensors and passes thepressure information on to a treatment tracking software application.The treatment tracking software application may thereafter be used bythe orthodontist or treatment professional in treating the patient. Thetreatment tracking software application may be used by athree-dimensional appliance printing system to create a subsequentappliance.

In an embodiment of the invention, the detection instrument interactswith the sensors in an office setting, such as the orthodontist's officeor clinic. In another embodiment of the invention, the detectioninstrument is provided to the patient for use in a home environment andthe detection instrument is configured to pass the pressure informationover a network such as the Internet to the treatment tracking softwareapplication residing in the orthodontist's office or clinic. Thereafter,the orthodontist or treatment professional may review the pressureinformation without the patient in the office, saving time and resourcesfor both the patient and the orthodontist. In some scenarios, thedetection instrument may not be configured to pass pressure informationdirectly from the patient's home to the orthodontist's office. As such,the patient may also be provided with a communication device forfacilitating the transfer of information from the detection instrumentto the treatment tracking software application. For example, thecommunication device may include a cellular network interface card oranother mechanism for passing information between the detectioninstrument and the treatment tracking software. The communication devicemay comprise the patient's own computing device, such as a smartphone ora tablet computer, with an application installed thereon to facilitatecommunication between the patient's computing device and the treatmenttracking software application. In an embodiment of the invention, thedetection instrument may be the patient's own computing device with anapplication installed thereon. In this embodiment, the particular signalgenerating and receiving features of the underlying personal computingdevice are utilized, such as near field communication (NFC) technologyor similar.

The system may include transporting the non-treatment aligner and thefirst aligner to the patient. After bonding the anchor the body, thereceiving structure may be configured to release the anchor from thebody.

Illustrative embodiments of apparatus and methods in accordance with theprinciples of the invention will now be described with reference to theaccompanying drawings, which form a part hereof. It is to be understoodthat other embodiments may be utilized and that structural, functionaland procedural modifications may be made without departing from thescope and spirit of the present invention.

FIGS. 1A, 1B and 1C illustrate an embodiment of polymeric shellappliance 10. Polymeric shell appliance 10 may be used in securingattachments on a patient's teeth. Shell appliance 10 includes body 11.Body 11 may be formed of a unitary piece of material or printed using astereolithography (SLA) process. Body 11 may include cavities 12.Cavities 12 may be configured to conform to surfaces of the patient'steeth and to geometries shaped to receive and reposition the patient'steeth from one arrangement to a successive arrangement. Receptacles 14and 16 may be designed into one or more cavities 12 of body 11. In someembodiments, receptacles 14 and/or 16 may be receiving structures. Theareas of body 11 that include and/or surround receptacles 14 and/or 16may be named anchor-locating areas. Anchor-locating area 17 may be shownin FIG. 1A and in FIG. 1C. An anchor-locating area may be a portion ofappliance 10 for identifying a location on the patient's teeth in orderto place one or more anchors and/or attachments. Anchor-locating area 17may be an example of an anchor-locating area.

Polymeric shell appliance 10 is shown holding an orthodontic appliance,such as attachment 30. Attachment 30 includes bonding base 31.

FIG. 1C shows an enlarged view of a portion of appliance 10.Anchor-locating area 17 may be larger and/or smaller that what is shownin FIG. 1C. Anchor-locating area may be physically defined on appliance10. A physically defined anchor-locating area may include an etching ordotted line on appliance 10. Anchor-locating area may be not bephysically defined on appliance 10. In some embodiments, anchor-locatingarea 17 may include the entirety of appliance 10.

FIG. 2 shows polymeric shell appliance 10 holding attachment 30 withbonding base 31 against the labial side of tooth 20. The hold is in theposition in which attachment 30 was designed to function as part of anorthodontic aligner treatment. While attachments are currently the typeof appliance most often used with aligners, polymeric shell appliance 10may be used to position and bond other types of structures on teeth,such as brackets. Attachment 30, when bonded to tooth 20 by base 31, mayinteract with one or more aligners during the course of treatment.

Polymeric shell appliance 10 may be made using any suitable economicalrigid material. The material should preferably be biocompatible with theoral environment. The material should preferably be resilient andprovide effective reposition forces to the teeth to effect toothmovement relative to the pre-treatment location of the tooth. It shouldbe appreciated that an initial aligner used to place and bondattachments may be a non-treatment aligner—i.e., the initial aligner'sfunction may be to bond attachments to teeth and not to move teeth. Asubsequent aligner may be applied after the initial aligner's placement.The subsequent aligner may apply forces and effect treatment, such astooth movement. The material used to manufacture shell appliance 10should preferably be capable of being formed with cavities 12 to conformto the shape of the patient's teeth. The material should preferably becapable of being formed with receptacles 14 and/or 16. Receptacles 14and/or 16 may preferably conform to the shape of the desiredattachments. The attachments may be pre-loaded into the receptacles inadvance of aligner treatment.

In some embodiments, polymeric shell appliance 10 may be molded fromthermoplastic material—i.e., substances that can be re-melted back intoa liquid form. In other embodiments, polymeric shell appliance 10 may bemolded from thermosetting material—i.e., substances that set permanentlywhen heated by applying the thermosetting material to a positive dentalmold of the patient's teeth under the application of heat. Polymericshell appliance 10 may be molded from any other suitable moldablematerial. During the molding process, the mold may be formed bycomputer-controlled equipment to conform to the three-dimensionalportion of a crown of the patient's tooth. The mold may be furtherformed to include a template of an attachment located on or close to thethree-dimensional portion of the crown. In some embodiments, polymericshell appliance 10 may be 3D printed.

FIG. 3A shows an elevational view of appliance 10. According to oneembodiment, releasable adhesive or coating 15 contacts a portion ofsurface 13 that lines receptacle 14 (and receptacle 16) and a portion ofattachment 30 thereby releasably supporting the attachment 30 inreceptacle 14. Adhesive 15 may be configured to hold attachment 30within the shell during transport—e.g., shipping—to the orthodontistand/or patient. Adhesive 15 may securely hold attachment 30 until theattachments are mounted to the patient's teeth prior to start of alignertreatment.

The shell may be shipped together with a plurality of aligners for eachrespective stage of treatment. Releasable adhesive 15 may be any ofseveral types of adhesive, such as a pressure sensitive adhesive, whichretains the attachment in the receptacle while permitting detachmentunder the application of a requisite force, such as a pressure sensitiveadhesive.

In some embodiments, releasable adhesive 15 may be a type of adhesivewhich retains the attachment in the receptacle while permittingdetachment under the application of a liquid, such as water or saliva.In this embodiment, the attachment may detach from the receptacle whenplaced in the liquid environment. Such a liquid environment may includea patient's mouth.

According to one embodiment, curable dental adhesive 33 may bepre-applied to base 31 of attachment 30. Curable dental adhesive 33 maybe used to bond attachment base 31 to the tooth surface when the shellappliance 10 is placed over the arch of the patient during attachmentinstallation.

Alternatively, the orthodontist and/or patient can apply dental adhesive33 to base 31 of attachment 30 prior to placing appliance 10 over thepatient's arch and bringing attachment 30 into contact with tooth 20.Any suitable adhesive may be used to bond orthodontic appliances toteeth. An exemplary adhesive may include a type of adhesive applied bythe practitioner prior to placing the shell appliance on the teeth.Another exemplary adhesive may include a type of adhesive that ispre-applied to the attachments upon manufacture. In certain embodiments,shell appliance 10 may be manufactured with adhesives 33 and 15 by thesupply company prior to being provided to the orthodontic practitioner.

According to another embodiment, handle structure 50 may be provided onbody 11 of polymeric shell appliance 10. Handle structure, if provided,is preferably located on an outer, labial-facing, surface of body 11.Although handle structure 50 is shown on a lingual-facing side in FIG.3A, it may be preferable for handle structure 50 to be located on anouter, labial-facing surface, for ease of use. Handle structure 50 maybe configured to be graspable by the patient or orthodontist. Handlestructure 50 may have a paddle shape or any other suitable shape forgrasping. Handle structure 50 may provide a convenient means of removingthe shell appliance after attachments have been installed to the teeth.

Polymeric shell appliance 10 may be oriented over the crowns of theteeth of the arch. The practitioner and/or patient may apply shellappliance 10 to the teeth by lightly pressing shell 10 over the crownsof the teeth, as shown in FIG. 2. The practitioner and/or patient maycontinue to apply light pressure to shell appliance 10 until cavities 12of shell appliance 10 are completely seated against the crowns, and theteeth are encapsulated in cavities 12. FIG. 2 may illustrate the teethencapsulated in cavities 12.

FIG. 3B shows a close-up view of attachment 30.

FIG. 4 shows body 11 in contact with tooth 20. As shown in FIG. 4, whenbody 11 encases tooth 20, the surface of tooth 20 may contact curableadhesive 33.

FIGS. 5A, 5B, 5C and 5D show a method of application of attachment 30 totooth 20 in a perspective view. FIG. 5A shows shell appliance 10 withattachment 30 located therein. FIG. 5B shows polymeric shell appliance10 being fitted on the arch of the patient.

FIG. 5C shows that once polymeric shell appliance 10 is fitted on thearch of the patient, curable dental adhesive 33, which was pre-appliedto base 31 of attachment 30, may contact the respective tooth in apredetermined target location. This curable adhesive may be UV curable.This UV curable adhesive may be activated by exposure of the adhesive toultraviolet light from curing gun 34 applied by a practitioner. Whenpolymeric shell appliance 10 is correctly situated, and is providingproper alignment of attachment 30, the curing light may be applied tothe teeth. The curing light may be applied to the teeth through theclear polymeric shell. The curing light may activate/set the adhesiveand bond base 31 to the surface of tooth 20.

FIG. 5D shows that, after the adhesive between attachment 30 and tooth20 has set, and attachment 30 is bonded to tooth 20, the releasablyadhesive bond, created by releasable adhesive 15, located between shell10 and attachment 30, can be broken. The bond may be broken using avariety of methods, such as application of the requisite pressure.Accordingly, the practitioner may remove shell 10 by applying a force,to shell 10, sufficient to break the bond between shell 10 andattachment 30.

Another method of removal of shell 10 may include moving polymeric shellappliance 10 occlusally toward the opposite arch, thereby causingadhesive 15 to release from attachment 30. Attachment 30 may remainbonded to tooth 20. Upon bonding of attachment 30 to tooth 20, thepractitioner may then remove the non-treatment polymeric shell appliance10, which may have been used to place and set attachment(s), from thepatient's mouth. Once shell appliance 10 is removed from a patient'smouth, the patient may begin treatment by applying an initialorthodontic aligner to the specific arch for which it was designed.

In some embodiments, in addition to positioning and installingattachments prior to aligner treatment, shell 10 may be configured toact as the first stage of aligner treatment and apply forces to thepatient's teeth. In such embodiments, after installation of theattachment to the teeth, the aligner may be worn by the patient for apredetermined time period to effect a requisite amount of movement ofthe patient's teeth. Upon completion of the predetermined time period,appliance 10 may be removed and the patient may wear a subsequent-stagealigner. The subsequent-stage aligner may be engaged with, or makecontact with, the attachments remaining from the first aligner stage.

The locations of receptacles 14 and/or 16 may be located within cavities12 on body 11. The locations may be based on three-dimensional scan datathat reflects (or captures) the teeth. The three-dimensional scan datamay be the output of a three-dimensional scan of the pre-treatmentmalocclused condition of the teeth. 3D scan data of a patient's teeth intheir pre-treatment positions may be received by a computer system. Thecomputer system may segment the teeth. The computer system may design analigner treatment plan comprising several stages of treatment. Thedesign may be completed in an automatic manner. The design may becompleted with operator assistance. Each aligner included in thetreatment may move teeth to successive intermediate positions. Each ofthe intermediate aligner stages may move the teeth closer to a desiredfinal treatment outcome. In the event that the treatment plan includesthe initial application of attachments to the teeth, attachments ofspecific sizes and shapes can be automatically generated and bepositioned to be applied to specific teeth on the 3D representation ofthe patient's dentition. Then an aligner can be designed withreceptacles 14 and/or 16 to receive and interact with the attachments.The attachments and positioning thereof may generate the requisiteforces to achieve desired tooth movements across the stages oftreatment.

In another embodiment, an operator may be involved in digitally stagingthe aligner treatment plan on a computer system. The operator mayretrieve an attachment from a library of attachments. The operator maythen manipulate and apply the retrieved attachments to a digital dentalmodel. Once an acceptable treatment plan that incorporates the use ofattachments into multiple stages of aligners has been developed,aligners may be manufactured. The newly manufactured aligners mayinclude corresponding receptacles for placement of the attachmentstherein. Alternatively, a corresponding non-treatment aligner may bedesigned for each aligner stage for use in placement and bonding ofattachments to the patient's teeth.

Custom attachments can be designed using a 3D image of the patient'spre-treatment dentition. The custom attachments may make it possible toconform the base of the attachment to the labial surface of thepatient's teeth. However, even when the appliance is not custom or isnot completely customized, attachments can be curved to conform to theaverage contours of the respective teeth.

Manufacture of shells 10 may be accomplished by any of several methods.The methods may use various types of equipment responsive tothree-dimensional data of the patient's teeth. Such methods may includedirect manufacturing by 3D printing. Such methods may includethermoforming atop molds made on 3D data driven equipment.

FIG. 6 shows a single tooth view of steps of a method of application ofshell 10 over tooth 20. FIG. 6A shows shell 10 and attachment 30included therein with removable adhesive. FIG. 6B shows shell 10encompassing tooth 20. A curing light may be applied to attachment 30through shell 10 in order to bond attachment 30 to tooth 20. FIG. 6Cshows shell 10 being removed from tooth 20 upon bonding of attachment 30to tooth 20. FIG. 6D shows attachment 30 bonded to tooth 20.

FIG. 7A shows an enlarged portion of a prior art system. Aligner 40 maybe filled with flowable-dental-composite material to create attachment42. Attachment 42 may be formed by hardening/curing a flowable dentalcomposite. Once cured, curable adhesive 33 may be used to bondattachment 42 to tooth 20. It should be appreciated that flowablematerial has many disadvantages, as described in greater detail in thebackground of the invention. Included in those disadvantages may beflowable material may be difficult to manipulate, require a large amountof patient chair time, and result in inconsistent attachment dimensionswhich vary from that which was planned during digital case setup.

FIG. 7B shows custom pre-formed attachment 30 releasably attached toappliance/aligner 10 by releasable adhesive 15. Curable adhesive 33 maybe used to attach attachment 30 to tooth 20.

It should be appreciated that, in FIG. 7B, releasable adhesive 15 may beembedded in appliance 10. It should also be appreciated that adhesive 33may be embedded in attachment 30.

A system in accordance with the present invention allows for limitlessattachment designs and more accurate placement of attachments. Becauseformation of the attachment is not limited to form in accordance withthe dimensions of the cavity as is the case for flowable dentalcomposites used in the creation of attachments in conventional systems,custom pre-formed attachments allow for the use of customizableattachments. Custom pre-formed attachments can be applied and installedusing the first aligner of a treatment sequence. As shown in FIG. 7B,custom pre-formed attachments may not be dependent on the shape of thealigner cavity. While a specific attachment design is shown in FIG. 7Bfor illustrative purposes, it is to be understood that a system inaccordance with the present invention allows for attachment designswhich deviate from the strict dimensions of the aligner and alignercavities. The custom pre-formed attachment may be designed to includepredetermined contact points 24 between the aligner and the attachmentallowing for the creation of forces on the teeth which are not possiblewith conventional systems for designing and applying attachments whichrely on the curing of flowable materials within a cavity of the aligner.

A first non-treatment aligner may be designed specifically for use inplacing and securing attachments at specified locations on the teeth.The first aligner may be separate and distinct from aligners to be usedin treatment. The first aligner may be similar to a bonding placementjig.

Once the attachments are bonded, as described above, the firstnon-treatment aligner can be discarded, and the first treatment alignercan be applied to the teeth. The first non-treatment aligner can beconfigured to apply the attachments at a predetermined offset in orderto create a more effective force when the treatment aligners areapplied. In other words, the attachment should create a force on thealigner during treatment. As described in the background, conventionaltechniques include guesswork, rely on the first aligner for thetreatment process to both create and set attachments and require apractitioner to apply the attachments to the teeth. Embodiments of theinvention provide a solution that does not require a practitioner toapply a dental composite inside the aligner. Embodiments of theinvention also remove the guesswork associated with aligner placement,because a template aligner is provided, which, when placed on the teeth,put the attachment in the precise location designed by the treatmentplan. It should be noted that the location for placement of theattachment designed by the treatment plan may be different or offsetfrom the respective position and configuration of the correspondingreceptacle designed in the treatment aligner(s) for interacting with theattachment. Such an offset can be used to control force vectors andcreate custom-designed teeth movements.

When a non-curable adhesive is used to bond the attachments, this systemallows patients to self-apply attachments without a visit to theorthodontist and/or dentist. Currently, more complicated aligner casescannot be completed without practitioner intervention because thepractitioner must apply attachments to the teeth at multiple stages oftreatment. Embodiments of the invention would remove the necessity forthe orthodontist to apply attachments because the aligner treatment planwould come with non-treatment aligner(s) preloaded with attachments withpre-applied adhesive. In some embodiments, a curable adhesive can beused with patient-applyable attachments. In these embodiments, apatient-applyable curing light device may be used by the patient to curethe adhesive.

FIG. 7C shows custom pre-formed attachment 30 releasably attached toappliance/aligner 10 by releasable adhesive 15. Curable adhesive 33 maybe used to attach attachment 30 to tooth 20.

It should be appreciated that, in FIG. 7C, releasable adhesive 15 may beembedded in attachment 30. It should also be appreciated that adhesive33 may be embedded in attachment 30.

FIG. 7D shows custom pre-formed attachment 30 releasably attached toappliance/aligner 10 by releasable adhesive 15. Curable adhesive 33 maybe used to attach attachment 30 to tooth 20.

It should be appreciated that, in FIG. 7D, releasable adhesive 15 may beadhered to attachment 30 and appliance 10. It should also be appreciatedthat adhesive 33 may be adhered to attachment 30 and tooth 20.

FIG. 8 shows aligner 10 that includes various attachments 30. Aligner 10may be fully positioned over the teeth. In the embodiment shown in FIG.8, aligner 10 may completely cover the teeth.

One of ordinary skill in the art will appreciate that the elements andsteps shown and described herein may be utilized and/or performed inother than the recited system and/or order and that one or more elementsillustrated may be optional. The methods of the above-referencedembodiments may involve the use of any suitable elements, elements,computer-executable instructions, or computer-readable data structures.In this regard, other embodiments are disclosed herein as well that canbe partially or wholly implemented on a computer-readable medium, forexample, by storing computer-executable instructions or modules or byutilizing computer-readable data structures.

Thus, systems and methods of manufacture of dental appliances and otherappliances using 3D printing, and products produced therefrom, have beenprovided. Persons skilled in the art will appreciate that the presentinvention can be practiced by other than the described embodiments,which are presented for purposes of illustration rather than oflimitation.

What is claimed is:
 1. A custom dental anchor application appliance formounting one or more anchors to teeth of a patient for use inorthodontic aligner treatment, the appliance comprising: a body havingat least one anchor-locating area; wherein the body comprises areceiving structure, said receiving structure being located within theanchor-locating area, for holding at least one dental anchor of apredefined configuration in a fixed position and orientation relative tothe body to bring a mounting surface of the anchor into contact with amounting area on the surface of a tooth when the mounting surface of theanchor is in conforming contact with the mounting area on the surface ofthe tooth, and wherein, upon bonding of the anchor to the tooth, thereceiving structure is configured to release the anchor from the body.2. The dental anchor application appliance of claim 1, wherein the bodycomprises a shell having a plurality of cavities, wherein at least oneof the cavities has geometries shaped to receive teeth and wherein atleast one cavity includes the receiving structure.
 3. The dental anchorapplication appliance of claim 1, wherein the receiving structure on thebody has a coating of releasable dental adhesive thereon.
 4. The dentalanchor application appliance of claim 1, wherein the appliance isconfigured to be used as a first aligner of an aligner treatmentprocedure.
 5. A method of producing a custom dental anchor applicationappliance for mounting one or more anchors to teeth of a patient for usein orthodontic aligner treatment, the method comprising: forming adental appliance, wherein the appliance comprises: a body having atleast one anchor-locating area shaped to conform to a mounting area onthe surface of at least one tooth; and a receiving structure configuredto removably support at least one dental anchor of a predefinedconfiguration in a fixed position and orientation relative to the body.6. The method of claim 5, wherein the forming is done using athree-dimensional printing approach.
 7. A method for applying one ormore dental anchors to teeth of a patient for use in aligner treatmentusing a custom dental anchor application appliance including a bodyhaving at least one anchor-locating area shaped to conform to a mountingarea on a surface of at least one tooth, the body including a receivingstructure for removably supporting at least one dental anchor of apredefined configuration in a fixed position and orientation relative tothe body to bring a mounting surface of the anchor into contact with themounting area on the surface of the tooth when the body is in conformingcontact with the mounting area, the method comprising: placing thecustom dental anchor application appliance such that the anchor-locatingarea conforms to the mounting area on the surface of the at least onetooth; and removing the custom dental anchor appliance after the anchorhas been placed.
 8. The method of embodiment 7, further comprising,prior to the removing the custom dental anchor appliance, applying acuring light to the body of the anchor application appliance.
 9. Themethod of claim 7, wherein the anchor is removably secured to the bodyusing a pressure-sensitive adhesion device.
 10. The method of claim 9,wherein the custom dental anchor appliance is removed from the body byapplying pressure to the anchor of the tooth.
 11. The method of claim10, further comprising, prior to the removing, bonding of the anchor tothe tooth using removable cement.
 12. The method of claim 7, wherein ashape of the anchor is a first shape, and a shape of the receivingstructure is a second shape, and the first shape does not conform to thesecond shape.
 13. The method of claim 7, wherein a shape of the anchoris a first shape, and a shape of the receiving structure is a secondshape, and the first shape and the second shape are different shapes.14. A method for using a custom dental orthodontic aligner treatmentsystem, said system comprising: receiving a three-dimensional scan of apatient's teeth; computing a sequence of aligners required to conformthe patient's teeth to a desired formation; computing a size and alocation of at least one anchor required to secure each aligner of thecomputed sequence of aligners; three-dimensionally printing anon-treatment aligner for mounting the at least one anchor to thepatient's teeth, said non-treatment aligner comprising: a body having atleast one anchor-locating area; a receiving structure, said receivingstructure being located within a vicinity of the anchor-locating area,said receiving structure for holding the at least one dental anchor of apredefined configuration in a fixed position and orientation relative tothe body to bring a mounting surface of the at least one anchor intocontact with a mounting area on a surface of at least one of thepatient's teeth when the mounting surface of the anchor is in conformingcontact with the mounting area; a releasable adhesive between the atleast one anchor and the body; a second adhesive located mountingsurface of the anchor; and three-dimensionally printing a first alignerin the sequence of aligners, said first aligner includingpressure-sensitive sensors.
 15. The system of claim 14, wherein thesecond adhesive is removable cement.
 16. The system of claim 14, whereinthe second adhesive comprises engineered marine mussel protein.
 17. Thesystem of claim 16, wherein, upon completion of the aligner treatment,the at least one anchor is configured to be removed from the patient'steeth by exposing the anchor to an infrared light source and/or anultraviolet light source.
 18. The system of claim 17, wherein, thenon-treatment aligner is patient-applyable.
 19. The system of claim 17,wherein the non-treatment aligner is patient-removable.
 20. The systemof claim 17, wherein sensors are located within the non-treatmentaligner, said sensors being used to determine correct placement of theat least one attachment.
 21. The system of claim 17, wherein the sensorsare configured to determine teeth placement and pressure information,said teeth placement and pressure information being used to compute asecond treatment aligner.